Hospitalized patient falls are the most common adverse event reported in healthcare. Each year, the Agency for Healthcare Research and Quality reports that between 700,000 and 1,000,000 people in the U.S. fall in the hospital, resulting in over 250,000 injuries and up to 11,000 deaths. Falls with injury impact patients’ quality of life, the hospital's length of stay, costs and litigation. Rush nursing teams have reduced falls through increased education regarding the Morse Fall Scale (MFS), with a concentration on mental status.
Fall prevention begins by managing patient fall risk factors and the hospital’s physical environment. Rush nurses utilize an evidence-based fall-risk assessment scale to evaluate every inpatient’s risk. The Rush University Medical Center Fall Oversight Committee was concerned about increased organizational falls, with a fall rate of 0.38% in September 2023.
While reviewing unit-specific data, the committee identified that the surgical acute and intermediate care units had decreased patient falls. These nursing teams placed additional focus on the MFS a validated tool that ranks the likelihood of patients falling based on risk factors in six scored components: history of falling, secondary diagnosis, ambulatory aid, having an intravenous catheter, gait/transferring and mental status.
Mental status is the MFS factor that is often the most confusing to score. This score should be rated based on the patient’s understanding of their mobility, including limitations or demonstrating over-estimation of ability, rather than only the patient being alert and oriented. A patient who is alert and oriented but demonstrates impulsivity should receive a risk point, raising the fall risk. This detail was important for nurses to understand and to score consistently.
Clinical nurse leaders (CNLs) Rachel Filer, MSN, RN, CNL, CMSRN; Colleen Wallek, MSN, RN, CNL, CMSRN; and Jenna Maloney, MSN, RN, CNL, collaborated to create an educational PowerPoint presentation that reviewed how to complete mental status scoring accurately. The presentation included patient examples and interventions to implement for high-scoring patients, including bed alarms and staying at arm’s length in the bathroom. The education was provided to nurses during the shift change huddle. Then, a train-the-trainer concept was used to ensure that all nursing personnel completed the education within a month across all inpatient units.
After re-education, the MFS mental status scoring was more accurate and included patient impulsivity beyond alertness and orientation alone. This directed staff members to implement tailored fall prevention measures that reduced patient falls and improved patient safety.